Abstract Laparoscopic surgery is a standard technique for many surgical procedures, but imposes significant attentional challenges on the surgeon placing patients at greater risk. Although many training programs use simulators to allow individuals to practice their skills outside the operating room, there is no standard method to determine whether a surgeon has achieved or maintained laparoscopic proficiency. However, recent research shows that assessing laparoscopic performance with a secondary task based on attentional resource theory provides a more sensitive means of establishing a surgeon's skill. The objective of this proposal is to validate a new secondary task specifically designed to address the unique visual-spatial challenges associated with laparoscopic surgery. The new secondary task targets the spatial attentional skills needed to mentally translate 2-D display images into the 3-D operational space. The specific aims are to conduct a series of experiments using fundamental laparoscopic simulators, porcine models, and fresh cadavers and demonstrate that the secondary task can be used to measure characteristics of laparoscopic skill (i.e., skill acquisition, retention, overlearning, transfer from simulators to the OR, and emerging techniques - single site surgery). The outcome from this project will be an objective measure of laparoscopic skill tied to the unique visual-spatial requirements inherent in this form of surgery. The new secondary task does not replace traditional performance metrics of speed and accuracy, but instead provides an additional, complementary measure of proficiency. This research targets fundamental laparoscopic surgery skills and has the potential to benefit any medical specialty where laparoscopic surgery is performed. In addition, the proposed hardware/software configuration can be coupled to any spatial task where surgeons use a video/computer display to monitor their actions (laparoscopy, endoscopy, radiology, etc.), resulting in an objective assessment method that can be easily applied to a wide variety of existing and future simulator and display devices.